+ The New Epidemiology – Epidemiology of the 21 st century Pragna Chandrasekhar John Frias Promila...
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Transcript of + The New Epidemiology – Epidemiology of the 21 st century Pragna Chandrasekhar John Frias Promila...
+The New Epidemiology – Epidemiology of the 21st century
Pragna ChandrasekharJohn FriasPromila GonsalvesDhurv Misri
+Overview
Introduction to Epidemiology
Epidemiology in the 19th and 20th century
Diseases most prevalent 19th-21st century
Disease tracking and surveillance
21st century epidemiology – The “New” epidemiology
Training in applied epidemiology
Organizations involved in research and healthcare improvement
Epidemiology and Public Health
+Epidemiology
What is epidemiology?
What does it entail? Populations Measurements Comparison Multidisciplinary aspects
+Types of Epidemiology
“Shoe leather”
Microbial
Descriptive
“Risk factor”
Clinical
Molecular
Genetic
“Big”
Global
+19th and 20th Century Epidemiology
The dramatic decline of infectious diseases are attributable to these socioeconomic factors: Better sanitation and hygiene Discoveries of antibiotics and vaccines Quarantine and isolation Involvement of government in legislations Scientific and technological advances in detecting
and surveillance of infectious diseases
+19th and 20th century Epidemiology Sanitation and
Hygiene 19th century increased
population Industrialization and
migration Inadequate public water
supplies and poor waste management system
Around 1900s, repeated outbreaks declined with improved public health Chlorination of water
(1900s Animal and pest control
programs Proper waste disposal
Vaccines Various vaccine
campaigns virtually eliminated diseases
Eradication of small pox
+19th and 20th century Epidemiology
Antibiotics Discovery of penicillin
by Alexander Fleming (1928)
Antibiotic treatment used by civilians for about 57 years
Problem: Emergence of drug resistance in several disease-causing microorganisms
Quarantines and Isolations 1600s practices of
isolation and quarantine employed to prevent spread of certain diseases
Subsequently, 1800s, these practices had become common in the American colonies.
+19th and 20th century Epidemiology
Government Involvement in Legislations 1950s epidemiology
widely recognized with discovery of lung cancer linked to tobacco smoking
Scientific and Technological Advances Serological testing Viral isolation and
tissue culture Molecular technique
+TIMELINE OF PREVALENT DISEASES
+Prevalent diseases in the 19th Century
MALARIA
Caused by the female Anopheles Mosquito
400-900million infected 1-3 million death
yearly in the early centuries
225 million cases in 2009
CHOLERA
Infection of the small intestine - Vibrio Cholerae
8 million dead in India alone between 1900-1920
3-5million people affected worldwide yearly now 100,000-200,000
death yearly
BUBONIC PLAGUE
Third pandemic started in 1855 in China
Zoonotic disease by Yersinia pestis
12 million people died in India and China only
Last active case in 1959
+Prevalent diseases in the20th CenturySMALL POX
Caused by the Variola virus
Affects children and young adults
Causes lesions, fever, muscle pain and malaise
300-500million people dead
Eradicated in 1979
INFLUENZA
Spanish flu – 1918-1919
H1N1 influenza virus
More than 500 million infected with 50 -100 million death worldwide
Re-emerged in 2009 as Swine Flu
Killed more than 18000 people since 2009
TYPHUS
Caused by Rickettisiae – obligate parasite
Infected 20-30 million between 1918-22
Killed at least 3 million
Large decrease due to vaccines
+Prevalent Diseases in the 21st Century
AIDS First recognized in 1981
Caused by the Human Immunodeficiency virus
Killed 25 million people
About 40 million people living with HIV
CANCER Unregulated cell
growth
In 2008, 7.6 million death about 13% of the population
Projected increase of 45% in Cancer death by 2030
SARS Caused by SARS
coronavirus
Outbreak in 2002/2003
8,422 cases with 916 deaths
More potent in people >65 years; 50% mortality rate
+
+Disease Tracking & SurveillanceAdvancements in 19th & 20th Century
+
Diseases in red require immediate reporting by a physician, nurse, health care provider, healthcare facility, or school to the Department of Epidemiology.
Click icon to add picture
+Disease Tracking & SurveillanceWHO Reporting Requirements
Periodic Reporting Requirements
Items Mode of Communication
Immediate reporting
First identified individual fulfilling the confirmed case: - descriptive account of any evidence of human-to-human transmission including information about thenumber of cases and the likely chains of transmission· any unusual or unexplained events under investigation
E-mail or fax
Daily Reporting - number of confirmed cases- number of confirmed cases for which there is no reported at-risk exposure and no laboratory occupational exposure- number of confirmed cases for which exposure history is unknown or undetermined- number of persons for whom Diagnosis is being considered- number of new hospital admissions
E-mail, fax or via secure password-protected WHO Global Atlas web site upon request
Weekly Reporting
Case-based information in a line listing format including confirmed cases with updated results persons for whom diagnosis is being considered and discarded cases
+Disease Tracking & SurveillanceReporting Methods: The Great Divide
Developed Countries
Utilization of Emerging Technology and Social Trends
Advanced Communication System
Abundant Awareness & Preventative Methods Resources
Developing Countries
Creative Projects Utilizing Basic Technology
Broken Communication Infrastructures
Lack of Medical & Awareness Resources
+Disease Tracking & SurveillanceImpact, Issues, & the Future Direction
Impact Issues
Lag in Detection
Evolution of Drug-Resistant Strains
Broken Link in Communication Structure
Rapid Globalization
Disproportionate Allocation of Funds
+Training in Applied Epidemiology Epidemic Intelligence Service (EIS)
Attracts pool of candidates with PhDs and doctoral degrees
2-year program involving various training programs: Applied epidemiology Biostatistics Public health surveillance Scientific writing Working with media Emerging public health issues
Degree and licensing Requirements and Eligibility Physicians Doctoral-level Scientists Veterinarians
+Organizations Involved in Research and Health Care Improvements
World Health Organization – Global Smallpox Eradication Programme (1980)
American Public Health Association Epidemiology
Global Health Quality Improvement Public Health Initiatives
Society of Epidemiologic Research
+The New Epidemiology of the 21st century
Applies epidemiology to modern healthcare
Safety risks of drugs – Reye syndrome and aspirin
Disproval of “safety signals” – birth defects due to exposure to bendectine
Medication benefits in disease prevention – folic acid supplementation
Treatment patterns
Primarily: cost of drugs and treatment
Number of trained pharmacoepidemiologists very small
PHARMACOEPIDEMIOLOGY CHALLENGES
+
Advances in genomics, molecular studies, proteomics, likewise – dominates the field DNA transcriptional control
for population “stratification” and preventative measures
Human Genome Project Compilation of DNA
sequence variants Efficient, cost-effective
technology to determine polymorphic sites
Large-scale samples
Lack of statistical ability to interpret and analyze the plethora of data produced
Complex diseases difficult to identify in initial stages and replicate for research
Requirement of large tissue samples
Constantly changing methods of conducting studies
Lack of specifity in phenotype definitions leading to limitations in identifying chronic disease associations
MOLECULAR AND GENETIC CHALLENGES
The New Epidemiology of the 21st century
+Epidemiology and Public Health
“Methodologic backbone” of public health
Some discoveries made due to advances in the field: Identification of health and environmental risks due to use
of tobacco Linked neural tube defects in infants with folate deficiency –
prevention by fortification of wheat with folic acid Connected link between hepatitis B and liver cancer –
prevention by worldwide vaccination campaigns Played a major role in decline of cardiovascular deaths
+
Increased number of people survived to old age More healthcare required Research studies and clinical trials optimally distributed to
include all generations and those prone to premature mortality and disease
Drastic decrease in infectious and communicable diseases Emerging resistant strains!
Future control of infectious agents Globalization Bioterrorism Climate change
Epidemiology and Public Health – Successes of Epidemiology
+